As a health consumer, I welcome the Federal Government’s $500 million plan to halve waiting times in emergency departments. It is admirable, and in honesty there are few things that would break your heart more than seeing a member of your own family waiting on an ambulance trolley in a hallway for a day in an overstretched emergency department.
As a medical recruiter, and a former health service manager, I know that halving waiting times is most likely too good to be true.
In many hospitals, particularly in regional areas, management exacts severe pressure on emergency doctors to ensure that waiting times are reduced. This sometimes involves pushing them beyond reasonable hours of work, and most frightening - insisting that junior trainees work in supervisory positions, after hours with little or no support from senior staff.
Objections from these doctors, even when presented with solid evidence of unsafe work practices, fall on deaf ears, with junior and middle-grade doctors being told to harden up, ‘build a bridge’ and get over it. This is often coupled with overt and tacit threats that careers will be ruined if young doctors speak up about what is happening behind the emergency department doors.
We are aware of one regional hospital who has recently lost several emergency training registrars, senior-non specialist doctors, and specialist emergency doctors due to poor supervision systems, astoundingly unsafe work practices, and a despotic and incompetent management structure. For the people in that community, that means that waiting times will almost certainly increase.
Consequently, every day our medical locum agency fields calls from doctors who are at the other end of the mincing machine of emergency departments. They come to us looking for advice, a different option, and sometimes a fresh start. They are often despondent, disappointed, and unsure about whether they ever want to step into an emergency department again.
In 2008, the Garling Report highlighted an endemic system of bullying and harassment in emergency departments, and the propensity of managers in the system to connive and manipulate to meet waiting time requirements.
In one NSW hospital, there was the initiation of the virtual ward in the Emergency Department- a dodgy system whereby there were beds ‘in’ the emergency department in the physical sense, but metaphysically speaking (and for waiting period reporting purposes), patients in those beds just did not exist - it was the Art and Zen of Fudging ED Waiting times. In the report, Peter Garling SC gave candid and real accounts of the inexcusable retaliation exacted against one senior emergency doctor when he objected to the system.
So, those doctors who are told to ‘build a bridge’ often do. They leave their training, and hospitals to go do other things- sometimes out of medicine altogether. There is hope, though, as they are welcomed with open arms by hospitals around Australia (often private sector run) who have proper systems in place to manage and supervise doctors in training - and supported by the medical recruitment and locum agencies who place them there.
It might as well be $500 billion, for the good it will do in terms of changing and rectifying the pressure placed on doctors in emergency departments. Back to the drawing board, Mr Rudd.
This article was written by Shaun Hughston of the medical recruitment agency, Beat Medical.
Beat Medical specialises in placing doctors in permanent and locum doctor jobs throughout Australia. There is huge demand for doctors to take on locum jobs throughout Australia, visit www.beatmedical.com. au to find out more about the opportunities available.